Bleeding on probing

Guided by: Dr. Mayank Parmar Dr. Bansari Shah Dr.Mayur ParmarPrepared by: Meera Dobariya

ContentIntroductionGingival bleeding on probingLocal factorSystemic factorIn diagnosisbleeding point indexConclusion

IntroductionThe bleeding on probing is a

widely used clinical sign as indicator of the periodontal condition & disease progression.

Gingival bleeding on probingThe two earliest signs of gingival inflammation

preceding established gingivitis are1. Increased gingival crevicular fluid production

rate.2. Bleeding from gingival sulcus on gentle

probing.It has been shown that bleeding on probing

appears earlier than a change in color or other visual signs of inflammation.

Gingival bleeding on probing indicates an inflammatory lesion both in the epithelium & in the connective tissue.

Local factor associated with BOPContributing factors to plaque retention may

lead to gingivitis & ultimately leads to gingival bleeding on probing.

Example: caries,malpositioned teeth, mouth breathing, partial dentures, lack of attach gingiva,orthodonic treatment & fixed orthodontic treatment.

CHRONIC & RECURRENT BLEEDING: Most common cause is inflammation. Bleeding is chronic or recurrent & is provoked by

mechanical trauma. e.g.: from tooth brushing, toothpicks or food impaction. it also occur by biting in to solid food such as apple.

Histological evaluation revealed that in early stages of gingivitis, cytokines are responsible for connective tissue breakdown.

Matrix metaloproteinases also play a role in tissue breakdown.

Histopathologic alteration that result in abnormal gingival bleeding include dilatation & engorgement of the capillaries & thinning or ulceration of the sulcular epithelium.

After the vessels are damaged & ruptured interrelated mechanism induce hemostasis.

Vessel wall cntract,blood flow diminishes,blood platelets adher to the edges of the tissue , & a fibrous cloat is formed,which contracts & results in approximation of the edges of the injured area.bleeding recurs when the area Is irritated.

In case of moderate or advanced periodontitis the presence of bleeding on probing is a sign of active tissue destruction.

Laceration of gingiva by toothbrush bristales during aggressive toothbrushing or by sharp pieces of hard food can cause gingival bleeding even in the absence of gingival disease.

Gingival burn from hot foods or chemicals increases the ease of gingival bleeding,.

Spontaneous bleeding or bleeding on slight provocation can occur in ANUG.

Acute necrotizing ulcerative gingivitis

Gingival burns

l SYSTEMIC FACTOR:• Hemorrhagic disprdets in which abnormal gingival

bleeding is encounterd include:1. Vitamin C deficiency(scurvy):interdental &

marginal gingiva is bright red with swollen,smooth,shiny surface.in fully develope scurvy gingiva becomes boggy,ulcerated & bleeds.

2.Platelet disorders(thrombocytopenic purpura): abnormalreduction in number of circulating blood platelets.so patient develops focal hamorrhage into tissue & organs,including skin & mucous membrane.

3.Vitamin K deficiency:it is involved in prothrombin synthesis. It also regulates the level of factor VII,IX & X(proconvertin,Christmas factor & Stuart-Prower factor, respectively.)So leads to gingival bleeding.

Oral manifestation of scurvy Oral manifestation of purpura

4. Other coagulation defects: Hemophilia: characterized by prolonged coagulation

time & hemorrhagic tendencies. Gingival hemorrhage may massive & prolonged.

Leukemia: progressive overproduction of white blood cells which usually appear in circulating blood in an immature form. Oral manifestations are gingivitis, gingival hyperplasia, hemorrhage & ulceration of the mucosa.

Christmas disease: Also known as Hemophilia B,in which deficient level of coagulant factor IX(Christmas factor).

5. The effect of hormonal replacement therapy, oral contraceptives, pregnancy & the menstrual cycle are also reported to affect the gingival bleeding.

6.Diabetes: marked inflammation affects both epithelium & C.T., which leads to destruction of reticulin fibers.

7.Medication: Anticonvulsant, antihypertensive & immunosuppressant are known to cause gingival enlargement.

Drug induced gingival enlargement

Gingival inflammation in pregnancy

Hemophilia Leukemia

In diagnosis The insertion of probe to the bottom of the

pocket elicits bleeding if the gingiva is inflamed & the pocket epithelium is atrophic or ulcerated.

To test for bleeding, the probe is carefully introduced to the bottom of the pocket & gently moved laterally along the pocket wall.

Sometimes bleeding appears immediately after removal of the probe; other times it may be delayed for a few seconds.

Therefore rechecking for bleeding 30 to 60 seconds after probing.

Bleeding point index It is used for evaluation of gingival inflammation. For record the index retract the cheek & place the

periodontal probe 1mm into the sulcus or pocket at the distal aspect of the most posterior tooth in the quadrant on the buccal surface.

Carry the probe lightly across the length of the sulcus to the mesial interproximal area on the facial aspect.

Wait for the 30 sec. & record the presence of bleeding on the distal, facial & mesial surface.

Repeat the same for palatal/lingual surface. Percentage of the number of bleeding surfaces is calculated

by dividing the number of the surfaces that bled by the total no. of tooth surface(4 per tooth) & by multiplying by 100.

Goal of 10% or fewer bleeding points is good, but 0 is ideal.

conclusionBleeding on probing is indicates

the progression of attachment loss.

If periodontal treatment is successful, bleeding on probing will cease.

Thank you